Letters To The Editor Open Access
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World J Gastroenterol. Aug 28, 2017; 23(32): 6007-6008
Published online Aug 28, 2017. doi: 10.3748/wjg.v23.i32.6007
Comment on "Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis"
Huan-Huan Sun, Si-Lin Huang, Yang Bai, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
ORCID number: Huan-Huan Sun (0000-0002-7762-3260); Si-Lin Huang (0000-0003-4120-6307); Yang Bai (0000-0002-6991-9010).
Author contributions: Sun HH conceived and wrote the manuscript; Huang SL and Bai Y provided overall directions and contributed to revising the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest in association with this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yang Bai, MD, Professor, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou 510515, Guangdong Province, China. 13925001665@163.com
Telephone: +86-20-61641036 Fax: +86-20-61641049
Received: April 19, 2017
Peer-review started: April 20, 2017
First decision: May 12, 2017
Revised: May 28, 2017
Accepted: July 22, 2017
Article in press: July 24, 2017
Published online: August 28, 2017
Processing time: 129 Days and 20.1 Hours

Abstract

This is a comment on a meta-analysis of published studies comparing cold vs hot polypectomy. We believe that the conclusion of this meta-analysis that “cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy” needs more rigorous evidence.

Key Words: Cold polypectomy; Hot polypectomy; Colon adenoma; Meta-analysis

Core tip: This is a comment on a meta-analysis of published studies comparing cold vs hot polypectomy. We believe that the conclusion of this meta-analysis needs more rigorous evidence.
TO THE EDITOR

We read with interest the article by Fujiya et al[1] entitled “Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis”, which compared cold and hot polypectomy with respect to efficacy and adverse events. The authors attempted to perform a systematic review and meta-analysis of the “randomized controlled trials (RCTs)” from several databases, one of which is actually a retrospective study[2]. In addition, among the six included studies, two (one article[3] and one abstract[4]) actually utilized the same data, which is another serious issue.

Colorectal polyps can be divided into three groups based on size: diminutive (≤ 5 mm), small (6-9 mm), and large (≥ 10 mm). The American Society for Gastrointestinal Endoscopy recommends that cold snare polypectomy should be the primary modality used for resection of diminutive polyps. However, polyps that are 6 to 9 mm in size can be resected by cold snare polypectomy or hot snare polypectomy because the optimum technique is not defined[5]. In this meta-analysis, the authors demonstrated that cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy. However, among the six included studies, one compared hot snare, cold snare and cold forceps polypectomy for diminutive colorectal polyps[6], and the other five studies compared hot snare with cold snare polypectomy for small polyps (10 mm or less in diameter, and most were 8 mm or less)[2-4,7,8]. Hence, we believe that the conclusion is not sufficient.

All six included studies reported the rate of adverse events, including bleeding. The study by Horiuchi et al[8], however, focused on small colorectal polyps in patients receiving anticoagulation therapy. Thus, it should be excluded from this meta-analysis, or sensitivity analysis should be done to explore whether it was biased.

Footnotes

Manuscript source: Unsolicited manuscript

Specialty type: Gastroenterology and hepatology

Country of origin: China

Peer-review report classification

Grade A (Excellent): A

Grade B (Very good): B

Grade C (Good): C

Grade D (Fair): 0

Grade E (Poor): 0

P- Reviewer: Garcia-Olmo D, Hsieh YH, Paoluzi OA S- Editor: Gong ZM L- Editor: Wang TQ E- Editor: Xu XR

References
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